I am in Los Angeles this week for attending the International Stroke Conference 2016, back in town after 5 years. Two days and a half conference gathering basic scientists, nurses, physicians and other healthcare professionals (we estimate around 5’000 attendants) discuss about latest news in stroke research, from the bench to the latest innovation in clinic.
Today was a very informative day, with lot of good sessions that were going around. The day started early with a session at 7:00AM on the “blood-brain barrier during stroke injury” chaired by Professor Gregory Bix (University of Kentucky) that have a lineup of very good sessions. In particular, his research on the effect of extracellular matrix as an active actor of stroke recovery. A lot of scientists see the ECM as merely more than a scaffold for the maintenance of the blood vessels structures. Turns out it is more than just a protein scaffold and has indeed a important role to play in the cellular response to injury, especially during stroke injury. In particular, he showed that integrins (a class of proteins involved in cell-matrix interactions) has an important role to play in stroke outcome as his research showed that suppressing intern alpha5beta1 was having a dramatic effect on stroke infarct size and the BBB integrity. Another talk by Dr. Drittan Agalliu (Columbia University) shed some new lights on the disruption of tight junctions complexes during stroke with novel mechanisms and concepts that were until now not much investigated. Another presentation by Dr. Martha O’Donnell (University of California-Davis) raised the importance of ion channels and transporters in the brain endothelium during stroke injury, especially as an important mediator for brain swelling. We neuroscientists focus ion channels exclusively to neurons (due to their excitable nature), eclipsing their importance to other cells of the neuromuscular unit. Her presentation was indeed a great reminder of how such ion channels and proteins are important.
Finally the first session was concluded by Dr. Patrick Ronaldson (University of Arizona) that demonstrated that another class of transporters, classically referred as drug transporters, are also sensitive to stroke injury and that by better understanding how hypoxia/ischemia their expression, we may use it as a novel approach to deliver therapeutics across the BBB.
The second morning session that I attended was a discussion panel on using stem cells as therapeutics to stroke injury. It was a vivid and engaging session with several big names in the field including Pr. Steve Cramer (University of California-Irvine) that charismatically made a call to have more stem cell research into stroke research or Pr. Tom Carmichael (University of California – Los Angeles) describing over 15 years of stem cell therapy and stroke. It was amazing to see how far we came but also how too fast scientists and the general public may have been enthusiastic about it (as we were with gene therapy as well). We learned a lot in these last 15 years, we have seen huge progress in stem cell research. But we also have seen huge failure and disappointment as well. Some due to our knowledge at that time of stem cell biology but also due to poor designed clinical studies that resulted in disappointing results. This resulted in the field in a move similar to what have been done with experimental stroke model through the STAIR committee (Stroke Treatment Academic Industry Roundtable) that set guidelines and recommendations to have better models for stroke research with the creation of STEPS that try to apply the same guidelines and recommendation for stem cell-based therapies. One presenter used the analogy of the year of the monkey that comes back every 15 years. 15 years ago, stem cell therapy was very promising but suffered several setbacks. After 15 years, we are back into the year of the monkey and we have learned a lot from these cells. Maybe in the next year of the monkey, we may have some successful clinical trials.
One analogy used by Dr. Carmichael is the idea of versions. We had “stem cells v0.25” 15 years ago and we have been now in “stem cells v1.0” moving to “version 2.0”. I personally see the field ripe to use iPSCs to better model the neuromuscular unit during stroke injury and have a better bi-directional approach rather than the old linear “bench to bedside” to have a chance for finding some treatment to stroke injury.
The afternoon session was as good with small communications about basic mechanisms of stroke injury as well as poster tour. The nice thing about posters is it gives you time to meet and greet, ask questions and also find some old friends around. What I can say that by the end of the day, I was washed off metaphorically and literarily (rain was pouring down on LA when I was out back to my hotel and ended up soaked up well).